Healthcare Provider Details

I. General information

NPI: 1801234257
Provider Name (Legal Business Name): TERESE ANN OGRINC-PAULUS MLTASCT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 H STREET EAST
POPLAR MT
59255-0067
US

IV. Provider business mailing address

107 H STREET EAST
POPLAR MT
59255-0067
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-2172
  • Fax: 406-768-3435
Mailing address:
  • Phone: 406-768-2172
  • Fax: 406-768-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: